MEDICARE: ALPHA HOMECARE RESIDENTIAL SERVICES AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1326828062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA HOMECARE RESIDENTIAL SERVICES AGENCY LLC

Provider Business Mailing Address
First Line	:	2607 GLENRIVER WAY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-5178
Country	:	US
Telephone Number	:	703-945-2303
Fax Number	:	571-552-3147

Provider Business Practice Location Address
First Line	:	2607 GLENRIVER WAY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-5178
Country	:	US
Telephone Number	:	703-945-2303
Fax Number	:	571-552-3147

Authorized Official
Title or Position	:	CEO/ADMIN
Name	:	JOSEPHINE ALPHA
Credential	:	NURSE
Telephone Number	:	571-774-2345

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	06/04/2026

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